Simon Stevens' delivery plan for the NHS explained

Denis Campbell
Every A&E must put “comprehensive front-door clinical streaming” in place by October. Photograph: Peter Byrne/PA

The chief of NHS England, Simon Stevens, has pledged to make an array of changes to benefit patients in his proposals for the future of the health service.

In the delivery plan for his Five-Year Forward View, he sets out the way in which providers of NHS care must overhaul their working practices, despite the unprecedented pressures they are facing and the service having less money than he believes it needs to do its job properly.

The changes include:

  • Creating an England-wide network of about 150 urgent treatment centres to take the strain of overcrowded A&E units, which NHS chiefs say 3 million people a year visit unnecessarily with injuries and minor ailments. The centres will be open for 12 hours every day of the week and be staffed by GPs, other doctors or experienced nurses. “They offer patients who do not need hospital A&E care treatment by clinicians with access to diagnostic facilities that will usually include an X-ray machine,” the delivery plan says.
  • Every A&E must put “comprehensive front-door clinical streaming” in place by October, under which nurses or doctors assess how unwell patients are and direct them to the most appropriate service. New GP services at emergency departments will be one option, paid for by £100m announced in the recent budget. This aims to give A&Es more time to look after the sickest patients, who will often be frail and elderly.
  • GPs will have to offer evening and weekend appointments across the whole of England by March 2019, despite family doctors’ concern that there is too little demand from patients, especially on Sunday afternoons, and too few of them. NHS England are also pledging to put 3,250 extra GPs, plus 1,300 clinical pharmacists and 1,500 more mental health therapists, into GP surgeries by 2019, though sceptics have questioned where the new doctors will come from.
  • An overhaul of the NHS 111 telephone advice service aims to increase the proportion of calls that are answered by doctors, nurses and mental health specialists from 22% to 30% by March 2018. A new NHS 111 online service later this year will let patients enter symptoms and receive “tailored advice on management” of their illness.
  • Hospitals and local councils will work together to cut the number of patients stuck in hospital, despite being medically fit to be discharged, because of inadequate local social care. The aim is to free up 2,000-3,000 hospital beds so that hospitals can admit patients classed as a medical emergency quicker than is currently the case.
  • Early diagnosis of cancer should be improved through the creation of 10 regional rapid diagnostic and assessment centres. They aim to ensure that by 2020 every cancer patient is diagnosed within 28 days and, it is hoped, ensure that an extra 5,000 people survive their cancer over the next two years. A £130m expansion of precision radiotherapy will see 42 hospitals acquire or upgrade their equipment to achieve this.
  • Improvements to mental healthcare aim to provide “talking therapies” to 200,000 more people by March 2019, improved services for children and young people, including 150-180 extra inpatient beds to avoid under-18s having to travel far from home to get care, and the creation of four new mother and baby units to help women suffering postnatal psychological or psychiatric problems. The number of A&E units with mental health specialists on duty 24/7 should rise fivefold to 74 by 2019, and there will also be new dedicated mental health services for traumatised military veterans.
  • Millions of people in up to nine areas of England should receive better, more joined-up care when hospitals, GP surgeries, mental health and ambulance services and social care providers in each region link up to become the first wave of new “accountable care organisations”, which provide fully integrated care for all of a patient’s needs. The frontrunners to get approval to pioneer that approach are Frimley Health in Surrey; Greater Manchester; South Yorkshire and Bassetlaw; Northumberland; Nottinghamshire; Blackpool and Fylde Coast; Dorset; Luton, Milton Keynes and Bedfordshire; and West Berkshire.
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